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Particularitati ale sistemului respirator la copil Radu Tabacaru Spit Maria Curie Bucuresti
Particularitati ale sistemului respirator la copil
Radu Tabacaru
Spit Maria Curie
Bucuresti
Cuprins
• Particularitati fiziologice
• Particularitati anatomice
• Afectiuni respiratorii frecvente
• Echipament specific pentru copii
Plamanul
• Dezvoltare din tubul endodermic
• Nastere 1 milion alveole
• 1 an 100 milioane
• 6 ani 300 milioane
Particularitati fiziologice
• Complianta pulmonara = adult
• Complianta toracica >> adult
– Muschii intercostali se opun diafragmului
• Coaste orizontalizate
– Respiratie diafragmatica
• Rezistente crescute in caile aeriene Ø redus
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Particularitati fiziologice Nou Nascut Adult Unitati
FResp 50 ± 1 12 ± 3 Bpm
Vol curent 21 575 mL
6–8 6–7 mL/kg
Minut volum 1050 6400 mL/min
200–260 90 mL/kg/min
Ventilatie
alveolara
665 3100 mL/min
100–150 60 mL/kg/min
Vd/Vt 0.3 0.3
Vo2 6–8 3–4 mL/kg/min
CapacVitala 120 4000 mL
CRF 80 3000 mL
30 30 mL/kg
Capac Pulm
Total
160 6000 mL
63 82 mL/kg
Volu
m c
ure
nt
V insp r
ezerv
a
Capacitate
reziduala
functionala
Cap
acitata
e inspirato
rie
Capacitate
vitala
Volum rezidual
V e
xp r
ezerv
a
Volume pulmonare
Capacitate
reziduala
functionala
Volum rezidual
Volum inchidere
Capacitate
inchidere
Incepe inchiderea cailor aeriene
Capacitate
reziduala
functionala
Volum rezidual
Volum inchidere
Capacitate
inchidere
Incepe inchiderea cailor aeriene
Particularitati anatomice
• Capul voluminos (occiput)
• Gat scurt
Particularitati anatomice
Particularitati anatomice
Particularitati anatomice
• Glota sub forma de palnie (cartilajul cricoid mai ingust)
Particularitati anatomice
Epiglota lunga si sub forma de V
Particularitati anatomice
• Macroglosie
• Laringe inalt (C4)
Particularitati anatomice
• Trahee scurta (4-5 cm la nou nascut)
• Narine inguste
Afectiuni frecvente
• Medicale
Raceala comuna
• Tuse, rinoree, fara febra (redusa), conjunctivita
• 90% virusi din care 40% rinovirusuri
• Autolimitat dar:
– 4-6 sapt hiperreactivitate cai aeriene !!!
• Alte afectiuni: rinita vasomotorie, rinita alergica, laringita, traheobronsita, pneumonia
• Progreseaza: otita, sinuzita, pneumonie
Aspiratie de meconiu
• Frecv la postmaturi
• Meconiu in cailea aeriene
– Obstructie + inflamatie
– Pneumotorax (20%)
– Hipertensiune pulmonara
• Suport ventilator -frecvent
– HFOV
– Oxid nitric
Tahipnee tranzitorie a nou nascututlui
• Rezorbtie lenta a lichidului pulmonar
• 24-48 ore tahipnee, cianoza
• Rx hiluri accentuate, scizuri vizibile
• Supliment O2, CPAP nasal, IOT – VM
• DG ≠ pneumonie
Displazia bronhopulmonara
• Tahipnee, tiraj, supliment O2 > 28 zile
• Pacienti care au necesitat suport ventilator
• Prematuri >> NN la termen
• Risc↑ infectii
• Evolutie f. dificila a suprainfectiilor
• Risc ↑ deces
Mucoviscidoza
• Boala genetica
• Mucus vascos
– Plaman, pancreas, ficat, gl digestive,
– Manifestari pulmonare, digestive, hepatice
• Dg = boala pulmonara cronica, deficit pancreas exocrin, Na↑ in transpiratie
Mucoviscidoza
• Tuse cronica, infectii pulmonare frecvente/ cronice (stafilococ, pseudomonas)
• Evolutie → supuratie pulmonara cronica
• Complicatii: pneumotorax, hemoptizie, cord pulmon
• Denutritie severa
• Protezare respiratorie
– Pentru afect. potential reversibile: pneumotorax, hemoptizie, transplant pulmonar
Astmul bronsic
• Afectiune cronica
– Inflamatie
– Bronhospasm
– Edem
– Hipersecretie mucus
• Varsta de debut = 4 ani
– 60% remisiune in adolescenta
• Tratament
– O2
– Bronhodilatatoare b2 agonisti
– Anticolinergice (ipratropium)
– Cromolin
– Teofilina
– Inhibitori leucotriene (montelukast)
– Corticoizi
Bronsiolita
• debut 2-8 luni (max 2 ani)
• Infectie virala VSR
– Mucoasa bronsioleler =Edem hipersecretie
• Polipnee, tuse, wheezing, batai aripi nazale, tiraj
• Trat
– b adrenergice(adrenalina)
– corticoizi
Afectiuni frecvente
• Chirurgicale
Stenoza traheala
• Intubatie prelungita sau congenital
• Dg ≠
– laringomalacie,
– paralizia corzi vocale
– Membrana laringiana
Sechestratia pulmonara
• Defect embriogenetic
• Masa tesut nefunctional
• Tuse, pneumonie, insuficienta cresterii
Hernia diafragmatica
• Defect de inchidere a diafragm (stg)
• Hernierea continut abdominal in torace
Hernia diafragmatica
• Insuf respiratorie:
– Hipolazia pulmonara
– Distensia anselor/stomac in torace
• Urgenta medicala
– Ventilatie mecanica ↓ hipertensiunii pulmonare
Hernia diafragmatica
• Risc pneumotorax
– volume ↓ ,HFOV, NO
– Drenaj pleural imediat disponibil
• Interventie chirurgicala
– Integrarea viscerelor in abdomen
– Inchiderea defectului cu plasa
– Sindrom compartiment abdominal
Atrezi de esofag
• Saptamana 4
• Diverticul laringotraheal
• Septul traheoesofagian
• Separarea diverticulului de intestinul cefalic, in sens caudo-cranial
Atrezie de esofag
• 85%
• Atrezie esofag
• Fistula traheo-esofagiana distala
Echipament specific pentru anestezie
Masti faciale
Pipa Guedel
Masca laringiana
I-gel
Sonda intubatie
Dimensiunea sondei de intubatie
• <1500g = 2,5
• NN termen= 3- 3,5
• 1 an = 4
• 2 ani= 4,5-5
Complianta tuburi circuite
Va multumesc
